what happens after denial

joyj
on 10/10/06 1:27 am - Middle Island, NY

If you go through the insurance process and are denied then appeal and all appeals are denied can you reapply for the surgery at a later date?  I'm not there yet but am wondering what happens at that point. Thanks

Sarahlicious
on 10/10/06 7:43 am - Miami Shores, FL
I'm going to guess and say yes you can if the situation has changed...take for example. You get denied based on the fact you do not have proper documentation of 6 months diet...but you got weighed every month for 6 months. So you appeal and try and fight it...while in the mean time continue to see your doc and make sure he takes additional notes. So appeals process #1 goes to #2 and finally a complete exhauted appeals proccess and still denied. But now you have 4 more months of the new 6 months detailed documented supervised diet...so 2 more months later your surgeon submits a new claim with the new documented diet and you should be considered and hopefully approved!

I have Lipedema and Lymphedema. I also have a passion for Obesity and Health Insurance Advocacy

Blog: born2lbfat.com Facebook: Born2lbFat Twitter: @born2lbfat

joyj
on 10/10/06 11:51 am - Middle Island, NY

I actually have all the documentation, the insurance co keeps saying they are missing something--which is frustrating because they could be saying that with the paper right in front of them.  I guess what I was trying to ask is if you are denied and appeals fail, could you re-submit or is it just over? Truly frustrating which is probably their goal but I will keep after them. Thanks

Sarahlicious
on 10/10/06 12:13 pm - Miami Shores, FL
Well of course nothing stops you from resubmitting, however unless something is different nothing stops them from just denying again and maybe this time having justification for denying further appeals. I would suggest if they they deny and you have to do a second appeal get your own copy of all documents and send them together certified mail, return receipt...then call everyday and make sure every page gets into their system.

I have Lipedema and Lymphedema. I also have a passion for Obesity and Health Insurance Advocacy

Blog: born2lbfat.com Facebook: Born2lbFat Twitter: @born2lbfat

Sean_B
on 10/10/06 12:32 pm - Schenectady, NY
I could be wrong, but the way I understand it.... from what you're posting, you were denied because they were missing something.... you're not appealing, you're just giving them what they're missing good luck

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